Prediction of Class II improvement after rapid maxillary expansion in early mixed dentition

ABSTRACT Objective: To evaluate the effectiveness of rapid maxillary expansion (RME) on the sagittal dental or skeletal parameters of growing children with Class II malocclusion. Materials and Methods: A systematic review intended to identify relevant literature was conducted. The search was performed on Medline, Embase, Cochrane Library, and Scopus databases. Reference lists of the included articles were also screened for relevant documents. The qualitative assessment was performed according to the Methodological Index for Non-Randomized Studies (MINORS) tool, and the resultant data were grouped and analyzed concerning dental and skeletal sagittal effects of RME. Results: Of 25 screened studies, seven articles met eligibility criteria and were included. Study samples were observed during mixed dentition stage and characterized as having either Class II dental malocclusion or skeletal discrepancy. None of the included studies was a randomized clinical trial. Included controlled studies presented several inadequacies related to control group or lacked appropriate comparative statistical analysis. Besides being frequently based on deficient methodology, dental and skeletal sagittal effects of RME were either controversial or lacked clinical relevance. Conclusion: The effect of RME on the sagittal dimension of Class II malocclusions has not been proved yet. Future randomized controlled clinical trials are still needed to definitely address this question.

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Early management of class II division 2 malocclusion. Literature review

Revista Estomatología ◽

10.25100/re.v23i2.5788 ◽

2017 ◽

Vol 23 (2) ◽

Author(s):

Carolina Rodríguez-Manjarrés ◽

Margarita-Rosa Padilla-Tello

Keyword(s):

Treatment Options ◽

Relevant Information ◽

Class Ii ◽

Mixed Dentition ◽

Mandibular Advancement ◽

Maxillary Expansion ◽

Early Management ◽

Mandibular Retrognathism ◽

Dental Crowding ◽

Division 2

This paper presents the most relevant information about the class II division 2 malocclusion (II / 2) described in the literature and different treatment options based on orthopedics. Class II malocclusion is characterized by mandibular retrognathism and / or prognathic maxillary which could affect the molar relationship and considering the dental component is subdivided into Type 1, characterized by vestibular inclination of all upper incisors and Type 2 with upper central incisors retroclined and vestibularized lateral incisors. It presents multifactorial etiology. As reported by the literature, the incidence of malocclusion Class II / 2 ranges from 3-12%. It is characterized by different vertical, transverse, facial, skeletal and dental features that differentiate it from other malocclusions, and thus make decisions on time. Therefore, early treatment of this type of malocclusion, can reduce the possibility of surgery, minimizec the severity of the alteration in stomatological system functions and improve the overall appearance of the patient. The goals of treatment are directed transversely performing maxillary expansion to allow correction in alteration of the axial inclination of the upper incisors and solve dental crowding, leading to a malocclusion class II / 1, for further mandibular advancement. Keywords: Malocclusion, Class II Division 2, mixed dentition, functional orthopedics of the jaws.

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Comparison of the effects of rapid maxillary expansion versus Twin Block appliance on mandibular growth in skeletal Class II patients

BMC Oral Health ◽

10.1186/s12903-020-01344-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jia-Nan Zhang ◽

Si Chen ◽

Cheng-Yi Huang ◽

Chong Zhong ◽

Jing Jin ◽

...

Keyword(s):

Class Ii ◽

Rapid Maxillary Expansion ◽

Maxillary Expansion ◽

Fixed Appliance ◽

Mandibular Growth ◽

Twin Block ◽

Skeletal Class ◽

Skeletal Changes ◽

Skeletal Class Ii ◽

Growth Changes

Abstract Background This is a retrospective study that compares mandibular growth changes in skeletal Class II patients treated by rapid maxillary expansion (RME) and following fixed appliance with those patients treated by Twin-Block (TB) and following fixed appliance. Methods Fourteen patients treated by RME and following fixed appliance were included into the RME group. Fifteen patients treated by Twin-Block and following fixed appliance were included into the TB group. Lateral cephalometric radiographs taken before treatment and immediately after fixed appliance treatment were used to evaluate mandibular growth effects. Results The starting forms of the patients in the two groups were examined to be of good comparability. The mandibular length increased significantly in both groups as measured by Co-Gn, Go-Gn and Ar-Gn, but the TB group didn’t show more mandibular growth than the RME group (P > 0.05). Skeletal changes of the mandible in vertical dimension were different in the two groups. The change in FMA was 0.35° in the RME group, while the change was 2.65° in the TB group (P < 0.001). The change in LAFH was 5.14 mm in the RME group, significantly smaller than the change of 10.19 mm in the TB group (P < 0.001). Conclusion The investigated Phase I treatment with RME followed by Phase II treatment of fixed appliance achieved the same increases in sagittal mandibular growth and facial profile improvements as the Twin-Block therapy. The treatment with RME followed by fixed appliance was better for vertical control, while the treatment with Twin-Block followed by fixed appliance significantly increased the mandibular plane angle.

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Molar Changes with Cervical Headgear Alone or in Combination with Rapid Maxillary Expansion

The Angle Orthodontist ◽

10.2319/080207-360.1 ◽

2008 ◽

Vol 78 (5) ◽

pp. 847-851 ◽

Cited By ~ 2

Author(s):

Marcel Marchiori Farret ◽

Eduardo Martinelli S. de Lima ◽

Vanessa Pereira Araújo ◽

Susana Maria Deon Rizzatto ◽

Luciane Macedo de Menezes ◽

...

Keyword(s):

Class Ii ◽

Rapid Maxillary Expansion ◽

Control Group ◽

Maxillary Expansion ◽

Lateral Cephalograms ◽

Cervical Traction ◽

Permanent Molars ◽

Group 2 ◽

First Permanent Molars ◽

Group 1

Abstract Objective: To test the hypothesis that there is no difference in the distal movement of the maxillary first permanent molars when cervical headgear is used alone or in combination with rapid maxillary expansion. Materials and Methods: The sample was composed of 36 subjects (aged 9 to 13 years), treated in the Faculty of Dentistry, Pontifícia Universidade Cat;aaolica, Rio Grande do Sul, Brazil. The individuals were in good health and in their pubertal growth period. All had Class II division 1 malocclusion. The patients were divided into two groups: group 1 (22 subjects), Class II, with a normal transverse maxilla treated with cervical traction headgear (HG) 400 g 12 h/d, and group 2 (14 subjects), Class II maxillary transverse deficiency treated with rapid maxillary expansion plus cervical traction headgear (RME + HG). An additional group 3 (17 subjects) served as a control group and included individuals with the same characteristics. All subjects had two lateral cephalograms: initial (T1) and progress (T2), taken 6 months later. Differences between T1 and T2 were compared with the Student's t-test, and three groups were compared by the analysis of variance and Tukey multiple comparison test. Results: Results showed greater distal tipping and greater distal movement of the first permanent molars in group 1 (HG) than in group 2 (RME + HG), P < .05. No extrusion of first permanent molar occurred in either group (P > .05). Conclusion: The hypothesis was rejected. Cervical traction headgear alone produced greater distal movement effects in maxillary first permanent molars when compared with rapid maxillary expansion associated with cervical headgear.

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Long-term Anteroposterior and Vertical Maxillary Changes in Skeletal Class II Patients Treated with Slow and Rapid Maxillary Expansion

The Angle Orthodontist ◽

10.2319/071406-293.1 ◽

2007 ◽

Vol 77 (5) ◽

pp. 870-874 ◽

Cited By ~ 9

Author(s):

Roberto M. A. Lima Filho ◽

Antonio C. O. Ruellas

Keyword(s):

Profile Analysis ◽

Class Ii ◽

Rapid Maxillary Expansion ◽

Maxillary Expansion ◽

Entire Sample ◽

Skeletal Class ◽

Skeletal Class Ii

Abstract Objective: To evaluate a 10-year follow-up of anteroposterior and vertical maxillary changes in skeletal Class II patients treated with slow and rapid maxillary expansion methods. Materials and Methods: The sample consisted of 70 patients divided into two groups: (1) treated with a cervical headgear with expansion of the inner bow (CHG) and (2) using a Haas-type rapid maxillary expansion appliance in conjunction with cervical headgear (RME-CHG). The CHG group consisted of 40 patients (18 males and 22 females; average age 10.6 years at pretreatment [T1], 13.6 years at posttreatment [T2], and 23.6 years at postretention [T3]). The RME-CHG group consisted of 30 patients (14 males and 16 females; average age 10.4 years at T1, 14.0 years at T2, and 24.6 years at T3). The profiles of SNA and SN-PP angles showed no significant differences in either group at T1, T2, and T3 phases. Results: For the entire sample, the profile analysis between the phases showed reduction in the SNA angle from T1–T2 and an increase from T2–T3. The SN-PP angle showed an increase from T1–T2 and a decrease from T2–T3. Treatment of skeletal Class II patients with slow and rapid maxillary expansions was efficient and stable over the long-term. Conclusions: The profiles of SNA and SN-PP at T1, T2, and T3 achieved with slow and rapid maxillary expansions were clinically equivalent.

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3D mandibular positioning after rapid maxillary expansion in Class II malocclusion

Brazilian Dental Journal ◽

10.1590/s0103-64402011000500014 ◽

2011 ◽

Vol 22 (5) ◽

pp. 428-434 ◽

Cited By ~ 12

Author(s):

Carolina Baratieri ◽

Matheus Alves Jr ◽

Eduardo Franzotti Sant’anna ◽

Matilde da Cunha Gonçalves Nojima ◽

Lincoln Issamu Nojima

Keyword(s):

Lateral Displacement ◽

Three Dimensional ◽

Vertical Displacement ◽

Class Ii ◽

Rapid Maxillary Expansion ◽

Maxillary Expansion ◽

Retention Period ◽

Division 1 ◽

Maxillary Constriction ◽

Class Ii Division 1

This study investigated, using cone beam computed tomography (CBCT), the spatial mandibular positioning after rapid maxillary expansion (RME) in Class II Division 1 malocclusion. This prospective study evaluated 17 children (mean initial age 10.36 years old) presenting Class II, Division 1 malocclusion and skeletal maxillary constriction that underwent to RME Haas’ protocol. CBCT was performed before treatment (T1), immediately after the stabilization of expander screw (T2) and after the retention period of 6 months (T3). The scans were managed in Dolphin Imaging® 11.0 software, where landmarks (right and left condylion, right and left gonion, and menton) were positioned and measured in relation to sagittal, coronal and axial plane to verify, respectively, transverse, anteroposterior and vertical displacement of the mandible. Paired Student’s t-test was used to identify significant differences (p<0.05) between T1 and T2, T2 and T3, and T1 and T3. After RME, right and left gonion moved downward (1.11 mm and 0.89 mm) and menton displaced downward (1.90 mm) and backward (1.50 mm). During the retention period, only anteroposterior displacement was significant, with the right and left gonion (0.97 mm and 1.26 mm) and the menton (2.29 mm) moving forward. Three-dimensional assessment of the mandible in Class II Division 1 patients subjected to RME showed a transitory backward and downward mandibular positioning, without any lateral displacement. The 6-month retention period allowed the mandible shifting significantly forward, exhibiting a more anterior position compared with the initial condition, even remaining in a more downward direction.

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Mandibular response after rapid maxillary expansion in class II growing patients: a pilot randomized controlled trial

Progress in Orthodontics ◽

10.1186/s40510-017-0189-6 ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 7

Author(s):

Roberta Lione ◽

Valerio Brunelli ◽

Lorenzo Franchi ◽

Chiara Pavoni ◽

Bernardo Quiroga Souki ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Class Ii ◽

Rapid Maxillary Expansion ◽

Maxillary Expansion ◽

Randomized Controlled ◽

Pilot Randomized Controlled Trial

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Comparison of the Effects of Rapid Maxillary Expansion vs Twin Block Appliance on Mandibular Growth in Skeletal Class II Patients.

10.21203/rs.3.rs-73492/v1 ◽

2020 ◽

Author(s):

Jia-Nan Zhang ◽

Si Chen ◽

Cheng-Yi Huang ◽

Chong Zhong ◽

Jing Jin ◽

...

Keyword(s):

Class Ii ◽

Rapid Maxillary Expansion ◽

Maxillary Expansion ◽

Fixed Appliance ◽

Mandibular Growth ◽

Twin Block ◽

Skeletal Class ◽

Skeletal Changes ◽

Skeletal Class Ii ◽

Growth Changes

Abstract Background: This is a retrospective study that compares mandibular growth changes in skeletal Class II patients treated by rapid maxillary expansion (RME) and following fixed appliance with those patients treated by Twin-Block (TB) and following fixed appliance. Methods: Fourteen patients treated by RME and following fixed appliance were included into the RME group. Fifteen patients treated by Twin-Block and following fixed appliance were included into the TB group. Lateral cephalometric radiographs taken before treatment and immediately after fixed appliance treatment were used to evaluate mandibular growth effects. Results: The starting forms of the patients in the two groups were examined to be of good comparability. The mandibular length increased significantly in both groups as measured by Co-Gn, Go-Gn and Ar-Gn, but the TB group didn’t show more mandibular growth than the RME group (P>0.05). Skeletal changes of the mandible in vertical dimension were different in the two groups. The change in FMA was 0.35° in the RME group, while the change was 2.65° in the TB group (P<0.001). The change in LAFH was 5.14mm in the RME group, significantly smaller than the change of 10.19mm in the TB group (P<0.001).Conclusions: The investigated Phase I treatment with RME followed by Phase II treatment of fixed appliance achieved the same increases in sagittal mandibular growth and facial profile improvements as the Twin-Block therapy. The treatment with RME followed by fixed appliance was better for vertical control, while the treatment with Twin-Block followed by fixed appliance significantly increased the mandibular plane angle.

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Transverse effects on the nasomaxillary complex one year after rapid maxillary expansion as the only intervention: A controlled study

Dental Press Journal of Orthodontics ◽

10.1590/2176-9451.19.5.079-087.oar ◽

2014 ◽

Vol 19 (5) ◽

pp. 79-87 ◽

Cited By ~ 7

Author(s):

Carolina da Luz Baratieri ◽

Maheus Alves Jr ◽

Claudia Trindade Mattos ◽

Geórgia Wain Thi Lau ◽

Lincoln Issamu Nojima ◽

...

Keyword(s):

Nasal Cavity ◽

Treated Group ◽

Rapid Maxillary Expansion ◽

Mixed Dentition ◽

Controlled Study ◽

Control Group ◽

Maxillary Expansion ◽

Treatment Onset ◽

One Year ◽

Base Width

The aim of this study was to assess by means of cone-beam computed tomography (CBCT) scans the transverse effects on the nasomaxillary complex in patients submitted to rapid maxillary expansion (RME) using Haas expander in comparison to untreated individuals. This prospective controlled clinical study assessed 30 subjects (18 boys and 12 girls) with mixed dentition and during pubertal growth. The treated group was submitted to RME with Haas expander, retention for six months and a six-month follow-up after removal. The control group matched the treated group in terms of age and sex distribution. CBCT scans were taken at treatment onset and one year after the expander was activated. Maxillary first molars (U6) width, right and left U6 angulation, maxillary alveolar width, maxillary basal width, palatal alveolar width, palatal base width, right and left alveolar angulation, palatal area, nasal base width, nasal cavity width and inferior nasal cavity area on the posterior, middle and anterior coronal slices were measured with Dolphin Imaging Software(r) 11.5, except for the first two variables which were performed only on the posterior slice. All transverse dimensions increased significantly (P < 0.05) in the treated group in comparison to the control, except for alveolar angulation and inferior nasal cavity area (P > 0.05). Results suggest that increase of molar, maxillary, palatal and nasal transverse dimensions was stable in comparison to the control group one year after treatment with RME.

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A Functional Appliance System for the Correction of Class II Relationships

British Journal of Orthodontics ◽

10.1179/bjo.16.3.169 ◽

1989 ◽

Vol 16 (3) ◽

pp. 169-176 ◽

Cited By ~ 6

Author(s):

M. J. Trenouth

Keyword(s):

Case Report ◽

Class Ii ◽

Rapid Maxillary Expansion ◽

Posterior Arch ◽

Class Ii Malocclusion ◽

Maxillary Expansion ◽

Functional Appliance ◽

Twin Block ◽

Arch Width ◽

Removable Appliance

A technique is described for the correction of Class II malocclusion involving a functional appliance and consisting of three phases. 1. Adjustment of posterior arch width and dental alignment, using semi-rapid maxillary expansion by means of an upper removable appliance, to co-ordinate the anticipated positions for the arches. 2. Correction of the Class II dental relationships using a modification of the twin-block functional appliance. 3. Retention, using an upper removable appliance with a very steep anterior bite plane. The technique is illustrated by a case report.

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